Facet Arthropathy

Facet arthropathy is a type of arthritis that affects the small joints in your spine. Facet joints give your spine support and stability. They also guide movement, allowing you to bend and twist.

The ends of your spinal bones are covered with a smooth tissue called cartilage. It works like a cushion for your joints. Over time, cartilage can wear away. This makes your bones rub against each other. As a result, bone spurs (extra bone growths) and, sometimes, cysts (fluid-filled sacs) form.

If you have facet arthropathy, you might feel back or neck pain that gets worse when you make certain bending and twisting movements.

A healthcare provider can help you manage the chronic pain that this condition causes.

Types of facet arthropathy

There aren’t specific types. You may instead hear your provider use these terms to describe the location of the affected joint:

• Cervical facet arthropathy: Located in your neck
• Thoracic facet arthropathy: Located in your mid back
• Lumbar facet arthropathy: Located in your lower back

There are also two ways arthritis affects each joint:

• Bilateral: It targets both left and right sides.
• Unilateral: It targets only one side.

Facet arthropathy symptoms

Pain near your spine is the main symptom. It usually affects the area around the joint but can spread to nearby areas. Sometimes, you may feel referred pain. This means the pain shows up in a different part of your body than where it starts.

When you have facet arthropathy, you might feel:

• Aching or sharp pain
• Pain that gets worse with extension and rotation
• Stiffness
• Tenderness when pressed

Facet arthropathy causes

Facet arthropathy usually develops when the cartilage that cushions your facet joints wears down. This breakdown makes movement painful. The most common reasons for this include:

• Age
• Injuries
• Joint overuse
• Overweight or obesity
• Repetitive extension/twisting or poor lifting habits

Risk factors of facet arthropathy

You may have a higher risk of this condition if you:

• Are above age 45
• Have a BMI over 25
• Do physical work or hobbies that strain your back
• Have spinal disk degeneration (loss of disk height)
• Have misaligned facet joints (extra stress on the joint)
• Have weak spinal support muscles
• Had a past spinal surgery or injury

Complications of facet arthropathy

When the cartilage breaks down, your bones may rub against each other. This can lead to:

• Bone spurs
• Fluid-filled cysts
• Limited mobility
• Muscle spasms
• Spinal canal narrowing (spinal stenosis)
• Vertebra slipping forward (degenerative spondylolisthesis)

In rare cases, it may also cause spinal cord compression or cauda equina syndrome. Symptoms of these conditions can include arm or leg weakness or problems with bowel and bladder control.

How doctors diagnose facet arthropathy

A healthcare provider diagnoses facet arthropathy with a physical exam and tests. They’ll ask about your symptoms and medical history. Then, they’ll press gently on your spine to find the source of pain. To see the joints more clearly, they may order imaging tests, like a CT scan or MRI.

To confirm the diagnosis, your provider may inject a numbing medication into the nerves that supply the affected joint. If your pain improves while the medication is active, it shows that facet arthropathy is the cause.

Stages of facet arthropathy

Your provider may use a grading system to describe how severe the condition is:

• Grade 1 (normal): No damage to your facet joint
• Grade 2 (mild): Small, noticeable changes in your joint
• Grade 3 (moderate): Some joint wear, thickening and possible bone spurs
• Grade 4 (severe): A lot of joint damage with severe cartilage loss and bone spurs

Different providers use different grading systems. Speak up if you’re not sure what your diagnosis means.

What is the treatment for facet arthropathy?

Treatment for facet arthropathy may include:

• Physical therapy: This strengthens your core and back muscles to support your spine.
• Medications: Pain relievers like NSAIDs (ibuprofen or naproxen) or acetaminophen reduce pain and inflammation. Some antidepressants, like tricyclics or SNRIs, can also help with chronic pain.
• Ergonomic adjustments: Sitting in a supportive chair or using posture aids may help you feel more comfortable.
• Activity changes: Avoiding repetitive or twisting movements may prevent flare-ups. Low-impact aerobic exercise, like walking or swimming, may help.

If these don’t provide enough relief, your provider may recommend:

• Facet joint injections: Your provider will inject an anesthetic (like the dentist would use) around the nerves to your facet joint to reduce pain and inflammation. This helps determine if radiofrequency ablation would be an option for longer relief.
• Radiofrequency ablation: Heat from a probe targets the nerves that carry pain signals from your joint. Relief usually lasts six to 12 months. You may need the procedure again.
• Cryotherapy: This freezes the facet nerves to stop pain signals.
• Chemical neurolysis: A chemical, like phenol, destroys nerve fibers that send pain signals.
• Surgery: If structural damage compresses nerves, your surgeon may remove part or all of the joint to relieve pressure and pain.

Living with chronic pain isn’t easy. You may benefit from speaking with a mental health provider. They can help you find coping strategies to manage day-to-day challenges.

When should I see my healthcare provider?

See a healthcare provider if you have chronic back pain that doesn’t improve with self-care, keeps getting worse or just won’t go away.

What can I expect if I have facet arthropathy?

Facet arthropathy usually gets worse over time. Once the joints start to degenerate, you can’t reverse the damage. Treatment can help manage symptoms. You might only notice pain with flare-ups after certain movements or when treatment wears off.

A healthcare provider will work with you, so pain doesn’t take over your daily routine.

Can facet arthropathy be prevented?

You can’t fully prevent this condition. Everyone’s facet joints wear down a bit with age. But you can lower your risk by:

• Not slouching or overstretching your back
• Maintaining a weight that’s healthy for you
• Staying active to keep core muscles strong
• Using proper techniques when twisting, bending or lifting

Facet syndrome vs. facet arthropathy: What’s the difference?

Facet syndrome and facet arthropathy are related but not the same. Facet syndrome refers to pain and other symptoms from a facet joint problem. Facet arthropathy is the degeneration, or breakdown, of the facet joint itself. Facet arthropathy can cause facet syndrome.